Embedding a just and learning culture in the NHS

In the development of health quality and patient safety policy over the years, the NHS has not been slow in creating important buzz words and concepts to describe its policies. We have had such terms as ‘patient advocacy’, ‘clinical and integrated governance’, ‘controls assurance’ and ‘intelligent transparency’ to name but a few. One of the latest is ‘a just and learning culture’. It is important to debate such concepts and terms as the discourse itself is useful in aiding further understanding and practical application. Often these concepts are very general in nature and have the potential to be used for very different and diffuse meanings.

It is important to remember that the label itself is not necessarily that important, it is the ideas behind it that matter. In patient safety and health quality there are many legal and ethical issues and the terms used can be broad and capable of several meanings. There are in law strict definitions of concepts, but the judges always try, certainly in tort law, to maintain their ability to be flexible in order to do justice in the case in front of them. It is not a good idea to be conceptually ‘boxed in’ with intransigent, strict definitions as that can close off discussion, end discretion and lead to debates becoming ossified and stale.